But Nice's 'appraisal document', published today, recommends that NHS patients should no longer try a second or third Anti-TNF if their first attempt has been unsuccessful.

Charities said it was established practice for doctors to try different versions of the drug until they found one that worked.

The British Society for Rheumatology Biologics Register shows around 70 per cent of patients will get a good response from a second Anti-TNF if the effects of the first start to wane.

Professor Rob Moots, a spokesman for the Arthritis and Musculoskeletal Alliance, said: 'It's almost impossible to know which anti-TNF will work for a patient at the outset.

'Before this decision we could try patients on each of the three treatments in turn to find one that was effective for them - now we only have one shot at success. This flies in the face of clinical judgment.

'Many patients will be left in astonishing pain while knowing we haven't explored all the options for them.'

Rheumatoid arthritis is caused by a faulty immune system and typically develops in patients' 30s or 40s.

It results in extreme pain and swelling of the affected joints. As it progresses, it can cause severe disability.

Patient groups will have a chance to appeal against today's decision before Nice's final guidance is issued in September.

It is thought that Scotland, where access to drugs is often determined separately, will in this case follow Nice's decision.